Liver transplantation for hepatocellular carcinoma without preoperative tumor biopsy.
BACKGROUND
Progress in liver imaging has made pretransplantation tumor biopsy no longer systematic in patients with hepatocellular carcinoma (HCC).


OBJECTIVE
Our aim was to evaluate the accuracy of a preoperative diagnosis of HCC based on clinical and radiological findings in 102 cirrhotics qualified for liver transplantation (LT) between January 1995 and August 2003 at our institution.


METHODS
The diagnostic accuracy of our policy was assessed by comparing pretransplant diagnosis with the pathologic report of explanted livers.


RESULTS
Sensitivity, specificity, positive, and negative predictive values for the preoperative clinical and radiological diagnosis of HCC were 89%, 94.3%, 77%, and 93.3%, respectively. A false-positive preoperative diagnosis was made in 20 of 102 patients (19.6%) (dysplastic nodules [n=9], regenerative nodules [n=5] cholangiocellular carcinoma [n=1], hemangioma [n=1], and no lesion [n=4]). All tumors larger than 3 cm were correctly diagnosed, irrespective of serum alpha-fetoprotein (sAFP) levels. The risk of overestimating the diagnosis of HCC in the subgroup of patients with tumors less than 3 cm was conversely correlated with preliver transplantation sAFP (sAFP<or=100 ng/L: 28%; sAFP>100: 11%; sAFP>200: 0%).


CONCLUSIONS
In cirrhotics with nodules larger than 3 cm irrespective of sAFP or nodules less than 3 cm with sAFP greater than 200 ng/L, the pretransplant diagnosis of HCC can be made without performing biopsy. In other cases (i.e., nodules less than 3 cm and sAFP lower than 200 ng/L), histologic confirmation of HCC or a close follow-up imaging should be considered.
Compagnon
Philippe
P
Service de Chirurgie Hépato-biliaire et Digestive, Hôpital Pontchaillou, INSERM U522, Université Rennes 1, Rennes, France. philippe.compagnon@chu-rennes.fr
Grandadam
Stéphane
S
Lorho
Richard
R
Turlin
Bruno
B
Camus
Christophe
C
Jianrong
Yang
Y
Lainé
Fabrice
F
Meunier
Bernard
B
Deugnier
Yves
Y
Boudjema
Karim
K
D000328:Adult; D000368:Aged; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000209:etiology / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D000509:alpha-Fetoproteins / Q000378:metabolism
C097353:AFP protein, human; D000509:alpha-Fetoproteins